| 1/28/98 |
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Here's a little tidbit for you, a fax I received from The Medical Management Institute (click) that ought to turn your stomach sour.
Please keep those cards and letters (ie., emails) coming with any new inside insurance company information that
you think the world ought to read.
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| 1/28/98 |
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FROM AN AUSTIN DOCTOR:
"Your comments about NYLcare/Ethix contract are right on the money.
I read it, highlighted the same paragraphs you reprinted, and
told my office manager to call their rep back and tell him that
I had laughed out loud when I read it (I really had)." (Scroll down to 1/17/98 to see parts of this absurd contract.)
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| 1/25/98 |
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God and the doctor we alike adore
But only in danger, not before.
The danger is o'er, both alike requited,
God is forgotten, and the doctor slighted. |
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--John Owen (1620)
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| 1/22/98 |
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BLUE CROSS has reduced its payment for Audiometry (Hearing Testing) from $54 to $22, a drop of 59%. We assume that you do 230 of these tests a year, doctor; so Blue Cross
just stole another $7,360 from your family and added it to their annual corporate profits.
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| 1/22/98 |
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ANTHEM just reduced their payment for a 25-Minute Detailed Office Visit (99214) from $83.84 to $62, a drop of 26%. Although this is not one of the E/M codes in our Standard Assumptions spreadsheet, obviously a loss of $21.84 for each such patient visit adds up to a lot of money over a year.
Anthem pays $37.26 for a 10-Minute Office Visit (99212), and it's interesting to note that
this rate of reimbursement would yield $93.15 if we see 2.5 patients
during the same 25-minute time period. This is how Anthem skews the reimbursement schedule to put overwhelming
pressure on doctors to rush more patients through our offices
faster because they pay us $31.15 more for seeing 2.5 patients in 25 minutes than they do for seeing
just one single patient for the entire 25 minutes. (See "Disincentives to Good Care")
PATIENTS, do you understand now why your doctor seems to be rushing you
in and out of the office these days? Doctors HATE doing that (we love to spend time with our valued patients), but your insurance company now forces us to practice that way.
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| 1/22/98 |
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Hmmmm. I wonder????
Has anyone noticed that there's recently been a marked decline in the number of fee reduction updates we've been posting here on "Bad News" every month? Ben Dover
certainly has observed a shrinking number, and you can see this
for yourself by scrolling though some of the earlier pages of
Bad News from last Fall.
I have actually been monitoring all this data closely in this
exact format for several years, quietly using it to shape my own practice. For years I've been
studying my daily reports, watching each of the various individual
companies' reimbursements sliding steadily toward the abyss. It
was only about six months ago that I got totally fed up with watching
the daily decay process all by myself and decided to create this
web site in order to share my information (and disgust) with rest
of my medical colleagues in real time. During the first few months
this site was on line last Fall, we all continued to observe together
the steady fee decay. Hardly a day went by that we didn't have
a few new fee reductions to report to all of you.
Yet lately (within just the past several weeks) we have been seeing
only a handful of new reductions. Why?
- Have the insurance companies suddenly become more benevolent toward
doctors and decided not to eviscerate us any further? Oh, sure!
If you believe that, you haven't been paying attention (see "Business is Business").
- Is this just an end-of-year (holiday) coincidence? Perhaps, but
I haven't recorded any prior seasonal variations in numbers of
fee reductions during my past years of monitoring.
- Is it possible that our strategy of spotlighting the cancerous
reductions might, just might be having a deterrent effect on the managed care companies? Has my Quixotic effort here been even a slight deterrence to
companies contemplating further fee decreases? I know for certain
that a number of the insurance companies monitor this site regularly,
and we can be sure they don't like having their fee reductions
thrown right in their faces with the world watching. Time will
tell us more.
Is our publicizing of the truth actually having an impact; or
am I just being naive? We can all hope, can't we?
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| 1/19/98 |
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BEN DOVER has heard rumors from several of the Austin surgeons who dropped off Blue Cross (click) that certain Blue Cross officials (we may decide to post
their identities later) have been trying to coerce Austin surgeons into accepting Blue Cross insurance again with thinly-veiled threats that Blue Cross might saturate the Austin market by bringing
in 10 new General Surgeons in the near future if the Austin surgeons refuse to knuckle under
to the absurdly low Blue Cross fee schedule (click).
BEN DOVER SEZ: If Blue Cross were to carry through on this threat to import
a bunch of new surgeons to "break" the existing Austin surgeons
(who are all highly experienced and widely respected by Austin
doctors and patients alike), what does that demonstrate clearly to patients who have Blue Cross
insurance?
- It shows that Blue Cross is not willing to pay a fair fee for their patients to have access to the best surgeons available,
those with years of experience and established reputations for excellence in the Austin medical community.
- It shows that Blue Cross is willing to deliver all its Austin patients into
the hands of a bunch of "mystery" surgeons with no established
Austin reputation whatsoever, surgeons about whom other Austin doctors know nothing at all.
How would you like to have an "unknown" surgeon operating on you...
or your child?
What kind of doctors could Blue Cross uproot and suddenly relocate
to Austin? No stable surgeon with a strong reputation built upon years of excellence
in his (or her) present community could possibly be induced to
suddenly walk away from a successful practice and a full life,
to leave his home and uproot his family in order to abruptly relocate
to Austin to become a cog in a corporate wheel. Good surgeons
almost never relocate once they've built a solid reputation for
themselves. Why would they? So what kind of surgeons could Blue Cross hire to be its "scabs"
in Austin?
- New surgeons fresh out of training - perhaps a few very good ones, many more perhaps not so good.
How could Austin doctors and patients possibly know the difference
between good and mediocre until some of them start screwing up...
maybe on your child? Think about it. If you were a young surgeon and knew you were one of the best
and brightest in your class, would you be willing to go on the payroll of a company like Blue Cross
that obviously holds the existing respected, established Austin
surgeons in such apparent contempt? If you were that bright, wouldn't
you realize that Blue Cross would end up treating you with the
same sort of distain as soon as you'd served your purpose as a
"scab"? If the best and brightest refuse to work as scabs, whom
does that leave? (See "More Malpractice")
- New surgeons from foreign countries whose visas will run out soon if they don't find a job in the
US.
- Older surgeons who have been unsuccessful in the community where they now live for one reason or another,
perhaps due to questionable competence or personality traits that
have prevented their practice from flourishing.
- New surgeons who don't care that it will be almost impossible for them to ever build a practice
in Austin independent of Blue Cross because no other doctors are
likely to refer patients to someone who tries to force his way
into the Austin medical community with a scarlet "A" hanging around his neck. A prostitute by any other name is still
a prostitute. If a doctor is not perceived to be a man of integrity, he will
never gain respect and acceptance as a peer within the Austin medical
community.
Blue Cross had better think long and hard before it begins moving
any "scabs" into Austin, and any potential scab surgeon ought
to think twice about the effect it will have on his entire future
career in medicine (anywhere in the US) if he sells his soul to
Blue Cross in 1998.
INTEGRITY IS LIKE FINE CRYSTAL - IF YOU GET ONE LITTLE CHIP OUT
OF THE RIM,
IT'S NEVER THE SAME.
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| 1/19/98 |
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MEDICARE just lowered its reimbursement for a Blood Glucose from $5.84 to $5.57, a drop of 5%. If we assume that you do just one of these a day in your office
to monitor your patients with diabetes, then Medicare just lowered
your annual income by another $62.10. I agree that this doesn't seem like much; but, as we've said
so many times on this site, a little here, a little there... it's
like being eaten to death by ants. The trend is inexorably downward.
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| 1/17/98 |
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ABSOLUTELY ABSURD!
the ARROGANCE of these companies is
BEYOND BELIEF!
Here are some quotes from the new
NYLCare/Ethix Contract! |
Paragraph V.A. "Physician recognizes and understands that such maximum allowable
fees may be changed by Ethix without notice to the physician."
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NYLCare/Ethix payments are abysmal (click) as it is, but now they're asking us to sign a contract
that gives them the right to lower fees still further any time they wish! And without notice!
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Paragraph V.B. "Physician recognizes and understands that Ethix will incur certain
costs and expenses in connection with marketing, administrative and other related management functions necessary to implement and operate the plan with respect to Physician's
services. Accordingly, Physician agrees to pay to Ethix an operational fee based upon
2.5% of allowable charges... Such operational fees shall be based on claims submitted to
Ethix and invoiced by Ethix no more frequently than on a monthly
basis."
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NYLCARE/Ethix already pays physicians the absolute lowest fee profile of any company listed on our Comparison Table (click), and they now propose to add on an additional 2.5% surcharge (!) for their own operating expenses (inefficiencies) which have
nothing whatsoever to do with providing good health care to patients
(which we doctors have continued to do despite plummeting incomes).
What do they mean "marketing"? They're not marketing doctors. Doctors don't need marketing. The only marketing Ethix is doing is marketing themselves with media advertising, etc.; and they want to charge us an extra 2.5% for that! (What's more, that 2.5% is also charged on the copay; so even
if a doctors is unable to collect the copay from a patient, the
company would still charge him the extra 2.5% surcharge on the
money he didn't collect!)
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| The executives at NYLCare/Ethix have got some serious NERVE to even propose such a RIP-OFF! We doctors certainly don't need them in order to do our jobs well. NYLCare/Ethix can't possibly run
their managed care scam on the public without our expertise and labors; yet they think
they can treat us like dirt. To heck with 'em! There's no way Ben Dover would ever sign this contract. |
ANY PHYSICIAN WHO SIGNS THIS CONTRACT HAS
LOST HIS MIND!
and deserves to get
TAKEN TO THE CLEANERS
BY NYLCARE/ETHIX |
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| 1/15/98 |
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Copied from the KXAN web page
(This was their lead story on the 6:00pm news today): |
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Doctors Have Difficulties With HMO's
 Many of us have suffered frustration in dealing with managed care,
but it seems the frustration is not limited to patients. An increasing number of doctors say HMO's are making it hard to
stay in business.
Statistics indicate that the average time spent with a primary
care doctor is less than 10 minutes per office visit. Relying
solely on HMO's, Dr. Patrick Pevoto says he would have to see
40 patients a day just to make ends meet. Such statistics are
leading some doctors to doubt an HMO's ability to provide quality
care. Dr. Pevoto says, "I decided that I would rather sacrifice
income to be able to do what I thought was right. To see a patient
for the amount of time, normally 20-30 minutes with each one,
versus 5 or 10 minutes when you can't even cover anything."
Doctor Pevoto isn't alone in his views, in fact a web site has been developed which focuses on issues such as these. The web site lists some opinions, but it also lists some numbers.
It rates the managed care organizations based on how much they
reimburse doctors for seeing patients. Three of the big ones,
Blue Cross/Blue Shield, Aetna and United (click) are listed as poor, bad and awful. Pevoto says, "No one can afford the bills and the staff it takes
to chase every claim and to make sure they get paid and all the
different things you have to do and that costs money."
News 36 began calling the insurance companies mentioned above
on Tuesday to give them a chance to respond. United Health Care and Blue Cross/Blue Shield refused comment while Aetna did not return several calls.
If you're concerned about the quality of care you're getting from
your doctor or the level of care your doctor is getting from your
HMO, you might want to check out the Medical Burnout Home Page. |
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| 1/14/98 |
"THE SITE EVERYONE'S TALKING ABOUT"
http://www.texmed.org/news_events/texas_medicine/ne_texmedfeatfeb98mb.htm
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| 1/14/98 |
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THIS JUST IN FROM THE AUSTIN RADIOLOGICAL ASSN:
"Because of Blue Cross Blue Shield's latest price cuts, the Austin
Radiological Association has chosen to not renew its contract as of January 1, 1998 for our private offices. This does not
affect the ARC HMO Blue, ARIA Healthselect, ARIA HMO Blue, HMO
Blue and Star HMO Blue.
"ARA will continue to provide service for Blue Cross Blue Shield
patients, but treat them as a commercial insurance, collecting
20% from the patient at the time of service."
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| 1/14/98 |
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Excerpts From
THE DALLAS MORNING NEWS
By Charles Ornstein
1/14/98
(for full text click http://www.dallasnews.com/business-nf/biz31.htm)
"Methodist Hospitals of Dallas said Tuesday that it would quit
Aetna Inc.'s health care networks in April to protest what hospital officials view as the insurer's
refusal to pay competitive fees to Methodist doctors. ... the
system's unusual stance will likely send a message to managed care companies that hospitals are growing increasingly frustrated by attempts
to rein in costs, said health care consultant Sandy Lutz. 'It's definitely hardball,' she said. Aetna's most recent troubles follow a defused threat (click) last summer by a group of 250 Dallas-area doctors affiliated
with Baylor University Medical Center. 'This has to escalate the
managed care wars,' Ms. Lutz said. 'Anytime you draw a line in the sand, it's going to be an example
to everybody else that they can draw a line in the sand, too.'"
BEN DOVER SEZ: Well, it looks like the doctors in Dallas are finally starting to get really mad. GOOD! It's about time they drew a line in the sand! Aetna's Fee Schedule (click) is terrible, and doctors would have to be fools to accept
any new patients from this company.
Our continuing question is why The Dallas Morning News refuses to give even the slightest mention
to this BURNOUT web site; so that the Dallas public might find its way here to the valuable
and timely information that's available. Many of you doctors have
written on behalf of this site both to the DMN Editor and also
to the author of this article, Charles Ornstein, asking them to
give us just a teensy bit of editorial mention; but it's been like hitting a brick wall. The insurance industry
spin doctors can spin out any false or hair-brained statements
they wish and count on having them quoted in the Dallas News,
but Ben Dover can't even get them to give a brief mention to our URL. WHY NOT? There is absolutely no other resource out there to present to
the public the plight of the individual Primary Care doctors who are being crushed by this managed care juggernaut. Those
readers wishing to comment on the value of this web site and why
the public ought to know about it may do so by sending an email to Mr. Ornstein (click).
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| 1/13/98 |
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FROM A DOCTOR IN PLANO, TEXAS:
"A detail rep gave me your site 30 min ago. What a wonderful place
to visit. Gee, I may even live here for awhile. I am a Family
Practice physician here in lovely Plano, Texas. I told all of
the HMO, PPO and the rest of the alphabet soup insurance companies
to take a hike in May of 1995. I told the US government goodbye
Jan.1, 1998. I still see 30-40 patients a day on MY terms. 1/3 to 1/2 of my patients are on some type of program, but their
relationship with a third party carrier has nothing to do with
my relationship with them. We can and WILL win this war, but we need to put the patients in a position of knowledge and control. They must be educated that they are spending THEIR money and
allow them to become more responsible for their informed consumption."
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| 1/13/98 |
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HUMANA has lowered its fee for a Complete Blood Count (CBC) from $26 to $24, a drop of 7.7%. Since we assume that you do 1,150 of these a year, doctor, Humana just stole
another $2,300 of your takehome pay and added it to their profits for the year.
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| 1/12/98 |
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BEECH STREET just cut its reimbursement for a Stool Guaiac test from $14.76 to $7.04, a drop of 52%. We assume that you do 690 of these a year, doctor; so if all your patients
had this insurance, Beech Street just took
another $5,327 out of your pocket and added it to their corporate profits for
the year.
Ben Dover hopes this is not the beginning of a downtrend in Beech
Street's payments, but we fear the worst. We'll keep you posted.
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| 1/8/98 |
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THIS FROM MICHIGAN:
"Oh, my God! I saw the address of your site at ___, a forum for pre/med students.
Your site has me shivering. I am really afraid of what the future holds for physicians who
are at the feet of those insurance bastards. I'm going to be entering med school this fall myself, and although I don't know which field I'm going to enter,
I know this sort of medical insurance rape is going to affect
me one way or another. You're doing a very necessary duty here.
Keep up the excellent work. (P.S. I will never view Prudential 'The Rock' ads in the same light again!!)"
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| 1/8/98 |
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| PLEASE SUPPORT OUR TMA |
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Texas Doctors,
All hell is going to break loose in the next year or two, andthe TMA is our most powerful resource in the looming epic
battle with the insurance industry. It is essential that all you
supporters of our Burnout web site do more than just sit there staring at your glowing
screens. Please become actively involved. Tell the officials of the TMA loud and clear what you expect
of them. Tell them you want them to give you an internet information source
like Burnout that covers all of Texas and every medical specialty.
We doctors must distance ourselves in the public's mind from the
managed care industry while making it clear that our values are
firmly planted on "The High Ground" when it comes to the welfare of our patients. Please consider
attending one or more of the TMA meetings listed below and making
your voice heard. Look around you because Ben Dover will be there listening, learning, taking notes (and maybe commenting) although
I won't be sporting that name on my nametag. (See if you can pick
me out, but don't expect me to admit it - smile). |
| Feb. 26-28 |
Austin |
Winter Leadership Conference |
| Apr. 22-25 |
Austin |
TexMed '98 |
| Sep. 17-19 |
Austin |
Fall Leadership Conference |
| Nov. 19-21 |
Austin |
Interim Session, House of Delegates, TMA |
|
